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Coaches Panel: How to overcome Achilles tendon problems

By VeloNews.com • Published: Mar 9th 2010 8:01 PM EST

Hi, I’m a 24 year old cat. 2 road cyclist and have a question regarding Achilles tendon pain.

I developed the pain at the end of November when making the transition from base work to on-the-bike power work. To give you an idea — Achilles pain on the bike (right foot) but only mild sensation when walking soon after riding.

My right femur is longer than my left, I ankle while pedaling, am flat footed, and over pronate. I haven’t changed anything regarding fit, shoe, cleat, or saddle position since spring ‘09 and have completed a full season of training and racing since. I do not have any history of Achilles injury, but have meniscus issues on the right side once in a blue moon, but only If I slack on stretching during hard racing/training.

The day after the pain surfaced I went for a short ride to see if it subsided but as soon as I started climbing it started to hurt. I live in a mountainous area so a flat/easy spin only happens on the trainer. When I got home there was very minor swelling in the area. To describe the pain it feels like I have a cut on my achilles or the back of my upper heel. I decided to take a week completely off and rest ( R.I.C.E) After that I rode easily on the trainer and felt fine. The next day I went to the roads and after about an hour of easy spinning felt the pain creeping in.

Now, I took two weeks completely off, after that I rode on the trainer every other day for 1 week for 45 mins to an hour, easy spinning — no pain. This week I started on the road again and after about two hours of the easiest spinning I could possibly ride I started to feel a dull pain coming back.

I’m hesitant to stretch to much at this point and am even questioning mobilization vs. immobilization. There are a few races in early March I targeted to win and the next major ones for me are in the summer. Every day that passes now I’m starting to come to the grim realization that the early races might not even be possible.

I do not have health insurance at the moment so it’s down to doing it Balboa style, which is fine but need the proper advice so I’m not digging my hole deeper. I’ve done research and talked with people about the issue and have heard everything thing from, ” it’s going to be like that for the rest of your life now but just tolerate it when you ride”‘ to “2 to 6 months completely off the bike” !! Any advice or help your able to give is always welcome.

Thank you! J

Jordan,

Sorry to hear about the pain. Let’s try to make some progress.

It sounds like you are doing some of the right stuff off the bike. When possible, try to use a lower gear, even if just one click. I know you mentioned there are hills in your area and I understand this may be tough. But, all the help you can provide the Achilles tendon will give you the best shot at recovery and getting back into full action.

I will try to keep the rest of the answer related to the equipment as best as possible and be mindful of your current situation regarding insurance.

FIRST:

You need to move the cleats toward the heel of your shoes. I like Speedplay road pedals best for this because they sell an aluminum fore-aft extender base plate. You can see more on their Web site under “The Ultimate Fit Tech Videos” section.

If your pedals/cleats do not allow for more movement of the cleat towards the heel of the shoe, it is time to switch pedals. If you are already all the way back with a Speedplay cleat, now is the time to get the adaptor plate.

I might consider trying the right cleat back one or two millimeters more than the left. Generally, I don’t like to suggest this but I think based on your symptoms it is worth consideration. This may add a bit of leverage (advantage) to your pedal stroke on the left side, which you mention has the shorter femur. Without this adjustment, the longer femur can sometimes have a bit more leverage which would add just a tab bit more stress down the leg while under load.

SECOND:

You mention that you “over-pronate.” I can guess your knees move inward toward the top tube during the down stroke while pedaling. This tendency is a classic sign of the need for wedges. I would suggest starting with 2 cleat wedges, at least, per foot. The thick part of the wedge should be on the inside of the foot (this is under-the-cleat wedges and not In-the-shoe wedges).

You can also see the installation of cleat wedges with a Speedplay cleat on their Web site. Add another wedge after a few rides if your knees still move inward. You will probably also need to move your foot in closer to the crank. You do this by pushing the cleat outward and away from the crank.

FINALLY:

It would appear you probably need more support inside the shoe, as well. Some inexpensive options are Superfeet or Specialized BG insoles. For simple over-the-counter products, they can be very good options.

I know you won’t like this. But, start back slowly on the bike after these changes. Hopefully, your current Balboa-style approach (including off the bike care) will help you get back on track.

And, let us know how it’s going …
- Paul Swift

Paul Swift

Paul Swift

An eight-time National Elite Cycling Champion and founder of BikeFit.com, Paul developed the Bicycle Fitting System (BFS), which includes products like the Cleat Wedges. The BFS helped bring the “front view” of a cyclist into the bike fitting world. BikeFit.com offers tools and education for bike fitters worldwide, helping them to better position humans on bicycles.

Any information or advice offered by the members of the Coaches’ Panel should not in any way be viewed as personal medical advice. The recommendations made in this column are offered as general information for healthy, physically fit amateur and professional athletes. None of the information provided by members of the Coaches’ Panel should be viewed as a replacement for personalized, professional medical treatment or to replace the advice or services of your physician. While some members of the Coaches’ Panel are Licensed Medical Doctors, Licensed healthcare professionals, and certified coaches, their advice in no way establishes a doctor-patient relationship between the writer and readers of this column. If you are beginning or resuming a vigorous exercise program, it is important to visit your health care provider for a complete physical examination in order to identify and treat any potential risks you might face.

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  • An orthopedic doctor would be the better person to give you advise since he can examine your heel/foot, make the diagnosis, and prescribe the treatment needed.
  • jsalcone
    I developed the same kind of Achilles tendonitis two years ago. My PT advised Superfeet, moving cleats back, frequent calf stretching, and some calf extensions (stand on stairs, push up with both legs, slowly come down with one leg, end heel below ball, repeat). Worked magic. It was gone in 4 weeks and I was back to full riding volume and intensity in 8.
  • Gary, Ohio
    Rub your tendons side-ways never long ways, that will close up the fibers. Sometimes rubbing or rolling your tendon sideways will have an instant effect, at least it does for me.GL.
  • Aldo Sfalcin
    "Out of the Canadian Coaching Manual" and from real experience.
    When an athlete is injured especially the Achilles tendon they must refrain from training or any exercise that effects the injury until the injury is 100% healed. Yeah 100%. Or it may become chronic.

    For the Achilles injury I'd recomment a lowering of the seat by a real expert who would know if you're too high (usual reason for the injury) . Do the cleat adjustment as recommended on this blog and start riding your bike with very light gears 42 x 18 only after the injury is fully healed.

    Increase the gears and distance slowly for as long as it takes to get back to normal and without ANY pain as your Achilles is retraining (base miles).

    In my 50 years experience as a rider and coach I can tell you that whole seasons were lost because racers would not TOTALY stop riding.

    I never saw an Achilles injury heal while still keeping actively cycling. I would like to know if anyone has.

    Waldo Jones (pen name) Level III Carded Coach)






  • jasoninbozone
    Hi all and thanks to Coach Paul. I have suffered with Achilles problems since riding half way up Haleakala. It has never fully healed. (har). But, maintenance is the key. A number one, according to my doc, DO NOT get any sort of steroid/cortisone shot. And B, I agree with Randy, the problem may not be your Achilles, it is more likely your calf, or, in my case, the popliteus and hamstring. These are tight on me all the time which puts a continuous but weak strain on the Achilles. My muscles respond very well to focused deep tissue massage. I recommend this with the commensurate gentle stretching. Finally, think of this as a way to work on your climbing IN the saddle. Climbing out of the saddle focuses all of that energy onto the Achilles. My climbing improved due to the injury. Once you are pain free then slowly bring out-of-saddle climbing back into your training.
  • Al
    I've had a similar issue twice over the last few years. I've riding the same bike with the same equipment and setup, so unlikely a issue with that. My physio indicated is was largely due to tightness in the calf muscles. that tightness causes the tendon to be stressed at all times. combine that with riding and you get micro tears that gradually get worse. 2 weeks of light riding, some physio (heat, tens, etc) and a lot of stretching rectified the problem.
  • dougstyle
    I had the exact same problem and nothing worked. I saw the two postings about using the Specialzied BG shoes and inserts and thought that it could not hurt to try. Saturday I took the Superfeet (Green) shoe liners out of my hiking boots and put them in my road shoes.
    Just like that the problem is fixed. This has been killing me since November and no one could give me the answer.

    Thanks for the input guys ! Rode Saturday and today with no pain.

    NOTE: remember to raise your seat to compensate for the height of the inserts.
  • Tendon Rupture Fail
    Good to hear that workedd Doug. Whether they're custom made orthodic inserts or a commercially available one remember once you move to wearing inserts and find it works you must use them all the time. Every single ride, not just occasionally when you feel pain.

    As mentioned earlier my achilles tendon ruptured just like JTW, whose question started this thread. For several years I could race with no pain as long as the orthotics were in. The same applied to boxing, a sport I took up after cycling. But one day I was late for practice and did 6 rounds of sparring without the orthotics. Damage was instant and pain constant thereafter. My physical therapist got me through the season by putting me on pain killers and walking on a cane when outside the ring, which saved wear and tear enough to fight three more months.

    Likewise in cycling you don't want to skip the inserts even once because injury could happen your first time without them.
  • dougstyle
    I appreciate the input. To clarify-are you saying that it is necessary to use them all the time or just when cycling due to the repetitive motion ?
     
     
    Please advsie.
     
     
     
    thank you,




    Douglas Redman
     
    512-269-6602 mobile
    866-599-9573 Toll Free 24 Hour Line
    wexfin@yahoo.com
  • Tendon Rupture Fail
    Douglas, pardon my delayed response. In your case IMO you should wear the inserts all the time, if they're the type that you can put into your walking shoes and cycling shoes. Wearing them everyday will slow down the erosion if you've got bad arches and for cycling you must wear them each training ride and race, or you'd risk re-injury. That's how I re-injured my achilles, by boxing without the inserts.

    Didn't wear them for cycling because I'd moved on to just track running and boxing. The injury was too painful and repetitive to give cycling another try. Since getting the custom made orthotics I wear them all the time, while walking and training.
  • dougstyle
    well, there goes my wearing of Crocs...
     
    I appreciate the answer. So you think that wearing a product like Crocs contribute the problem since they offer decent arch but little stability ?
     
     
    cheers, 




    Douglas Redman
     
    512-269-6602 mobile
    866-599-9573 Toll Free 24 Hour Line
    wexfin@yahoo.com
  • bradfoster
    Considering the achilles is the terminal end of the gastroc and soleus. Those two muscles need to be stretched, released, and able to contract/relax. Right now, you're probably would too tightly in a 'guarded' muscle tone around the clock. I'm the team chiro for both a euro and domestic based team. I use Active Release Techniques (ART) and would strongly recommend finding somebody in your area that is certified. www.activerelease.com
    As for treatments, 2-5 visits should have it taken care of. This should be easy to put behind you. I would also recommend decreasing the lever angle by sliding your cleats back towards your heel.
  • anonymus msk dr
    An additional thought would be to Google treatment of Achilles tendonitis. And start some eccentric calf raise on the step every night.
  • Humanperform
    Here is a link for a simple, effective and time efficient flexibility routine for cyclists. http://www.humanperformancecenter.com/
    Achilles tendonitis, tendinosis, tears and ruptures are all a result of an overloading of a common muscular pattern. If you want to rid yourself from achilles pain, you have to treat the injury but also address the kinetic patterns in the hips and legs through stretching and soft tissue mobilizations. Stretching an acute injury rarely is beneficial, but once it's in check, having a whole body stretching routine will keep a variety of injuries at bay. Flexibility for Cyclists Manual.
  • OB905
    One thing that you might try is something called a Strassburg Sock. You wear this at night and it gently stretches your Achilles Tendon while you sleep. I am an avid runner and occasional biker and went through an episode with Achilles problems about 7 years ago. I tried stretching, icing, and all sorts of strengthening exercises for about a year and had pretty much given up on being able to run competitively again. I tried the Strassburg sock and I was cured in 1 week, best $35 I ever spent. Since then I have loaned the sock to 2 other friends and they had the same results. Good luck to you
  • Richard McClung
    In addition to everything mentioned...

    Once, on the path to recovery, I found stretching and ankle rotations to be crucial in terms of preventitive maintenance.

    Another trick, once you begin riding again, is take some cloth tape and run a strip from under your heel, stright back to the top of the tendon where it connects to the calf muscle. Then place two or three pieces of tape across the long strip. What this does is make it impossible for you to drop your heel and stress the tendon. Be careful though, because this places more stress on your knee...you have to ride very lightly, and build back very slowly.

    I also was amazed how much walking with correct posture helped.
  • Dylan
    Take it easy off the bike as well, even if you feel fine in normal activity. I ruptured my achilles playing squash, but I think it was precipitated by hill training on the bike without sufficient stretching - I was getting very tight calf muscles riding in the weeks before my injury.
    Check out achillesblog.com for lots of blogs on achilles injuries and some good post-injury physical therapy plans.
    You really don't want to get to the stage where it ruptures, especially if you don't have health insurance. From what I've seen about treatment costs in the USA, you could fly to Australia, have the procedure done in a top private hospital, have a three week holiday, and still come out ahead financially.
  • jtwcook
    Thank you all for the advice. Shortly after I sent the e-mail to VN I actually ruptured the achilles. After much time off recovering, I am now able to ride a little here and there. There are some compensation pains that are surfacing in several areas but I am luckily getting a 3-D fitting next week to help. Once again thank you for sharing your experience and advice. JC
  • Tendon Rupture Fail
    JT sorry to hear you ruptured the tendon. I had the same symptoms and eventual injury as you -- it ended my cycling career. The author's feedback didn't consider you might have bad arches that require custom made orthodics. This was my problem and after the tendon rupture I got orthodics and was able to make all-league in HS track and cross country.

    You can adjust the cleats and do that other stuff to no end but sometimes there is no other solution but orthodics, as my physical therapist at the time said. Advice was a fail.
  • I had the Achilles problem too and found that most stretching makes it worse. The exception is this: Instead of putting your bad foot at 6 o'clock on the pedal stroke (as if you were stretching on a stair step), place the bad foot at 12 o'clock. Then gently, using your arm and upper body weight, apply downward pressure to the top of your thigh, just above the knee. It's easiest to do this stretch on the trainer, but you can also do it while you're out riding, whenever you start to feel a bit sore. Everyone is different, but this pretty much solved my problem. I did a double century with no pain a few months later. Call it the 12 o'clock stretch.

    I would also caution anyone against icing for too long. I once iced my Achilles for 20 minutes and when I unwrapped it, it looked like a frozen chicken breast. I then had to defrost it in the warm bath. I later found that 8 to 10 minutes worked best. Tendons have less circulation than regular muscle and freeze much faster.

    Good luck.
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